G-TECH Jobs

Engagement Description –

Analyze, investigate, and resolve appeals, complaints, and grievances. Provide comprehensive and thorough responses in compliance with CMS guidelines, state and federal regulations, and accreditations standards. Interact with internal and external customers and subject matter experts to gather information, build a case, and make decision to maintain or reverse appeal or grievance. Analyze and interpret systems data, contract language, regulatory provisions, and apply to casework. Adhere to policies, procedures, and audit standards to remain compliant and audit ready.

Top 3 Required Skills/Experience –

• Critical thinking, problem solving, analytical skills

• Letter writing and proofreading

• 2 years Customer service/concierge services

Required Skills/Experience – The rest of the required skills/experience. Include:

• PC Applications

• Excellent verbal and written communication skills

• Organizational/Time Management

• 2 years health insurance experience and familiarity with health insurance state and federal regulations

Preferred Skills/Experience – Optional but preferred skills/experience. Include:

• Project Management

Education/Certifications – Include:

• Bachelor’s Degree in English, Communications, or related field preferred.

Category Human Resources

Function HR / Benefits

Req ID JN -052023-120071